This invention relates to the evaluation and management of health problems and related disabilities. More particularly, this invention relates to the use of integrated structured methods, information systems, decision rules and practice guidelines to improve outcomes.
The present processes of medical diagnosis, treatment, and management of functional recovery are inconsistent. Often, the processes used for different individuals having similar health problems will vary significantly, yielding different results for each individual. Problems with the acquisition, recording, sharing, storage, comparison, and use of health and functional data underlie much of the observed inconsistency as detailed in the recent National Institute of Medicine reports on health care quality, which are hereby incorporated by reference in their entirety. Inconsistent care can be a major cause of medical errors, unnecessary lost time, and unnecessary costs. To the extent that people with health problems seek or receive diagnosis and treatment from a variety of sources or practitioners, the problems can be compounded.
Common problems with medical and disability data can include:                Incomplete collection of information needed for decision-making        Vague or incomplete descriptions of mechanisms of injury or illness, symptoms or signs        Conclusions or labels rather than underlying mechanisms of injury or illness, symptoms and signs        Illegible recording of data        Recording in chronological order rather than by problem        Use of paper records which cannot be easily sequenced, sorted, arrayed, compared, processed, or summarised        Existence of records in multiple locations        Lost, misfiled, or inaccessible records        
Even when electronic medical and disability management record keeping systems are used, common problems can include:                Storage of data in a manner such that it cannot be easily sequenced, sorted, arrayed, compared, processed, or summarised        Incompatible record formats or information systems within institutions and among parties involved in managing health or disability to another        Difficulty transferring information from one party involved in managing health or disability to another        
Practitioners rely on a knowledge base that was acquired during their initial training, reinforced or changed by experience, as well as continuing education, which is often sporadic and of variable quality itself. Consequently, problems often observed with the process of medical care are not only due to data collection, but can also be due to lack of a systematic approach to each class of health problems. Because comparisons to medical evidence are often not made during the process of care with respect to a class of health problems, errors in diagnosis and treatment result. The usual clinical and medical management approach is not systematic due to failure to compare each situation with validated information about:                Sensitive and specific, uniquely diagnostic symptoms, signs, manoeuvres and tests        Proven effective treatments        The effect of prior tests and treatments        The history and time course of a health problem        The context of the patient's health complaints        
Failure to consider the context and history of a health problem also contributes to variation in care. In making medical decisions, practitioners may not take into account:                The context and history of health complaints        Prior health problems and care        Previous provision and effectiveness of tests and treatment        The natural history, or course of a problem if untreated, compared to the course if treated        The course and effectiveness of the body's own healing process, sometimes in the face of continued exposures to etiologic factors for disease or injury        The contribution, or lack thereof, of a patient's own responsibility for health, health behaviours, and compliance with activity and treatment recommendations        The patient's social and work situation        
Problems frequently observed in the management of functional disability management include:                Assumptions that inactivity will enable healing and recovery        Lack of attention to the typical recovery period for a given health problem        Lack of attention to the essential physical and mental demands of work or school        Inattention to the social and work context of functional disability        Failure to use limited activity at work or school to support functional recoveryFinally, most health care systems lack timely and effective methods to measure patient and provider satisfaction with care, or to measure functional outcomes of care and disability management. There is therefore no way to correlate the process of care with its outcomes. Feedback of these data can lead to improvement in care.Practitioners often do not give patients enough understandable information to make informed decisions about their care and functional recovery. Valid information is not easily available elsewhere. Consequently, patients may ask for ineffective or unnecessary care, or may acquiesce to care or activity restriction that is not in their best interest based on the medical evidence.        
In response to variations in care and disability management and consequent unnecessary costs and functional disability, self-insured employers, insurers and other payers have attempted to manage care and disability. They have effectively become part of the health care system. However, the ability of case managers, utilisation review personnel, disease managers, and others acting on behalf of employees or payers to make logical, consistent decisions suffers from the same problems as those confronting health care professionals. Their access to data and consistent processes is in fact often worse, as they are one level removed from health care transactions and are hampered by communication problems.